tbuckley/cabot-search huggingface dataset:
Poster No. 132 HTAD PATIENT PATHWAY: Strategy for diagnostic work-up of patients and families with (suspected) Heritable Thoracic Aortic Diseases (HTAD). A statement from the HTAD Working Group of VASCERN
Authors: Julie de Backer, Maryanne Caruana, Marieke Baars, Evi Bashiardes, Kalman Benke, Erik Bjorck, Andrei Codreanu, Elena de Moya Rubio, Julia Dumfarth, Arturo Evangelista, Maarten Groenink, Klaus Kallenbach, Marlies Kempers, Anna Keravnu, Bart Loeys, Laura Muino Mosquera, Edit Nagi, Stefano Nistri, Guglielmina Pepe, Jolien Roos Hesselink, Zoltan Szabolcs, Gisela Teixido, Janneke Timmermans, Ingrid Van de Laar, Roland Van Kimmenade, Aline Verstraeten, Yskert Von Kodolitsch, Guillaume Jondeau
Journal: Cardiovascular Research (2022)

Abstract Background Timely diagnosis of patients with Heritable Thoracic Aortic Diseases (HTAD) is essential to avoid (often fatal) aortic dissection. Experts of the HTAD rare disease working group of the European Reference Network of Rare Vascular diseases (vascern) aimed to propose a pathway to: (1) improve patient care by diminishing time to diagnosis; (2) facilitate the establishment of a correct diagnosis, using molecular genetics when possible, which may lead to a more personalized treatment; (3) exclude the diagnosis in unaffected persons (family screening); (4) avoid overuse of financial and personnel resources. Material and methods This pathway is a consensus at expert level. It was generated based on available guidelines when possible. Discussion items were listed and, where necessary, items were included in a questionnaire sent out for voting and discussion over monthly teleconference calls. Results and conclusions Pathway Elements include Thoracic aortic aneurysm – and dissection, Bicuspid Aortic Valve, Medium-sized artery aneurysms/dissection, Extravascular features and Family History. Recommendations for the evaluation of patients and family members are provided. This pathway is advised to implement standardisation of diagnostic workup and follow-up of patients with suspected HTAD and the screening of their relatives and it focuses on patients with heritable aortic diseases whether syndromic or not. It is subject to adjustment with better recognition of new entities, and with the technical progress and increased availability of genetic testing.
Oral Presentation No. 068 Plasma fibrinogen independently predicts hypofibrinolysis in severe COVID-19
Authors: Diana Schrick, Margit Tokés-Füzesi, Barbara Réger, Tihamér Molnár
Journal: Cardiovascular Research (2022)

Abstract High rates of thrombosis are present in patients with SARS-CoV-2 infection. Deeper insight into the prothrombotic state is essential to provide the best thromboprophylaxis care. We aimed to explore associations among platelet indices, conventional hemostasis parameters, and viscoelastometry data. 21 patients with severe COVID-19 and 21 age-matched controls were enrolled. Each patient received 100 mg aspirin therapy at the time of blood sampling. To monitor the aspirin therapy, a platelet function test from hirudin anticoagulated whole blood was performed using the ASPI test by Multiplate analyser. High on-aspirin platelet reactivity (n = 8) was defined with an AUC &amp;gt; 40 cut-off value by ASPI tests. Furthermore, vitro viscoelastometric tests were carried out using a ClotPro analyser in COVID-associated thromboembolic events nor the survival rate showed significant associations with high on-aspirin platelet reactivity status. Patients presented with higher levels of inflammatory markers, along with evidence of hypercoagulability by ClotPro. H-IPF (%) was significantly higher among non-survivors (n = 18) compared to survivors (P = 0.011), and a negative correlation (P = 0.002) was found between H-IPF and plasminogen level in the total population. The platelet count was significantly higher among patients with high on-aspirin platelet reactivity (P = 0.03). ECA-A10 (P = 0.008), and ECA-MCF (P = 0.016) were significantly higher, while the tPA-CFT (P &amp;lt; 0.001) was significantly lower among patients with high on-aspirin platelet reactivity. However, only fibrinogen proved to be an independent predictor of hypofibrinolysis in severe COVID-19 patients. Surprisingly, a faster developing, more solid clot formation was observed in aspirin taking COVID-19 patients. In conclusion, an individually tailored thromboprophylaxis is needed to prevent thrombotic complications, particularly in the hypofibrinolytic cluster.
Clinical Case 15—Warburg effect and pulmonary embolism: a confounding clinical case
Authors: Gonçalo Rafael Marques Ferreira, Joana Correia, João Fiuza, João Miguel Santos, Vanda Neto, Joana Cunha, Filipe Fernandes, Inês Pires, Bruno Marmelo, Costa Cabral
Journal: Cardiovascular Research (2022)

Abstract Presentation A 61 year old man with a history of multiple lymph node metastasis of unknown primary cancer was admitted in the Emergency Room with sudden dyspnea preceded by left leg swelling. Physical examination revealed a blood pressure of 91/70mmHg, tachycardia, tachypnea and signs of deep vein thrombosis (DVT). Diagnosis and management Blood analysis showed increased serum lactate (SL) (5,5 mmol/L), a slight increase of cardiac enzymes and hypoglycemia, and imagiologic tests showed signs of bilateral pulmonary embolism (PE) and an increase of the right cardiac chambers. The patient was hospitalized with the diagnosis of intermediate-high risk PE. Because the patient presented persistent elevated SL and borderline hypotension, fibrinolysis was performed. However, the patient maintained high SL levels and hypotensive profile. After receiving the lymph node's biopsy result, which pointed towards a follicular lymphoma, the persistent hyperlactatemia, together with the hypoglycemic profile, was interpreted as a consequence of the Warburg Effect. Luckily, the patient didn't had any side effects of the fibrinolytic treatment. Learning points Acute high risk PE is marked by the presence of haemodynamic instability at presentation, and the finding of increased SL suggests peripheral hypoperfusion. Systemic thrombolytic therapy is indicated in most of patients with high risk PE. However, there are other causes of hyperlactatemia which the physician must be aware, as it can act as a confounder of PE risk assessment. The Warburg Effect may cause elevated SL in patients with cancer, which in turn are at risk of developing PE.
Clinical Case 23—Adult-onset recurrent Kawasaki disease complicated by coronary aneurysms and recurrent acute myocardial infarction
Authors: Mariana Margarida Ferreira Carvalho, Carolina Gonçalves, Margarida Cabral, Sara Lopes Fernandes, Rita Ribeiro Carvalho, Jorge Guardado, João Morais
Journal: Cardiovascular Research (2022)

Abstract Summary of case: A 67-year-old man presented to the emergency department (ED) with acute chest pain. He had the previous diagnosis of Kawasaki disease (KD) made when he was 51 years-old in a event of a acute myocardial infarction. Upon admission, his blood pressure was 100/70 mm Hg, heart rate was 55 beats/min, apyretic. Clinical examination was unremarkable. Electrocardiogram showed a synus rhythm without any ST-T alterations. An echocardiogram showed mildly decreased left ventricular function (LVEF) of 44% by the biplane Simpson method, with hypokinesia of anterolateral and inferolateral wall, and enlargement of the ascendent aorta and aorta root. Cardiac enzymes were elevated, troponin-I 10.5 ng/mL and NTproBNP of 832 ng/mL. The diagnosis of acute myocardial infarction without ST segment elevation was made. Cardiac catheterization revealed diffuse aneurysmal dilation of the left anterior descendent artery and right coronary artery. Circunflex artery was occluded in the mid segment. Thrombotic aspiration was made and a drug-eluting stent was implanted. The patient showed clinical improvement and was discharged 4 days later with ticagrelor and aspirin. This case illustrates the importance to recognize adult-onset KD as part of the differential diagnosis of chest pain with ST-segment elevation in a adult, even if uncommon. Early recognition is fundamental, permitting correct treatment and prevention of potentially fatal coronary complications.
Poster No. 080 Relationship between triglyceride glucose index, MACE and nephropathy in type 2 diabetes
Authors: Mercea Delia, Mociran Mihaela, Ianos Raluca, Sitar-Taut Adela, D Sporis, A Ganea, A Lazar, V Malinescu, A Cozma
Journal: Cardiovascular Research (2022)

Abstract Background The triglyceride glucose (TyG) index, a simple surrogate estimate of insulin resistance, has been demonstrated to predict cardiovascular disease morbidity and mortality in the general population. To explore the relationship between TyG index, MACE (major adverse cardiovascular events) and diabetic nephropathy in type 2 diabetes, we evaluated TyG index for 3 consecutive years. Material and methods This was a cross-sectional observational study that examined 172 subjects with T2DM. The mean age of the study participants was 61.71 ± 13.16 years, and 90 were female. The primary outcomes included the occurrence of MACE, defined as all-cause death, non-fatal myocardial infarction and non-fatal stroke. Subjects underwent a detailed standard evaluation to detect diabetic nephropathy (defined as urinary albumin excretion ≥ 30 mg/24 h). The TyG index was calculated as ln (fasting triglycerides × fasting glucose/2) and stratified into 4 quartiles (TyG-Q). The baseline characteristics of the study population in the four TyG-Q (Q1 (≤ 8.95) n = 43, Q2 (&amp;gt; 8.95 to ≤ 9.27) n = 43, Q3 (&amp;gt; 9.27 to ≤ 9.7) n = 43, and Q4 (&amp;gt; 9.7) n = 43) were analysed. Results and conclusions Higher TyG-Q correlated with the presence of nephropathy (p = 0.028), age (p = 0.0172), HbA1c levels (p = 0.001) and the presence of arterial hypertension (p = 0.032). The optimal TyG index cut-off for predicting MACE was 9.271 (sensitivity 54.0%; specificity 54%; area under the curve 0.532).The TyG index was significantly associated with MACE, suggesting that the TyG index may be a valid marker for risk stratification and prognosis in patients with T2DM.
Clinical Case 21—An unusual cause for hypoxemia and breathlessness
Authors: Margarida Gancho de Figueiredo, Sofia Paula, Samuel Almeida, Francisco Gomes, Filipa Ferreira, João Luz, Diogo Cunha, Oliveira Baltazar, Lurdes Almeida
Journal: Cardiovascular Research (2022)

Abstract 75-year-old woman with past medical history of ischemic stroke in 2019, when complementary diagnostic tests were performed and it was found that the patient had a patent foramen ovale (PFO). Current hospitalization due to COVID-19 pneumonia, which was complicated by bacterial co-infection and intermediate-low risk right main pulmonary artery thromboembolism. The patient was successfully treated, with improvement of the clinical condition and evident imaging resolution of pulmonary cavitations and recanalization of the right pulmonary artery. However, something intriguing was observed: the patient presented dyspnea in the upright position and a decline in transcutaneous oxygen saturation from 96% in the supine position to 85% in orthostatism, with reversal of these findings with the recumbency. This led to the suspicion of platypnea-orthodeoxia syndrome. A transesophageal echocardiogram with bubble test was then performed, revealing an atrial shunt in the supine position without Valsalva maneuver. With these evidences, the diagnosis of platypnea-orthodeoxia syndrome was made. Even though the patient was &amp;gt;60 years, due to important right-to-left shunt, the history of stroke and the current platypnea-orthodeoxia, it was decided to close the PFO. The day after the procedure, the patient was placed in the upright position, maintaining an oxygen saturation of 96%. This case is an example that the decision of closing PFO must be individualized, not focusing only on patient's age, but also on his medical history and current situation, as indicated in the 2022 Guidelines for the Management of Patent Foramen Ovale. Figure 1Transesophageal echocardiogram showing interatrial communication.
Clinical Case 03—Coronary subclavian steal syndrome: an unusual cause of acute myocardial infarction
Authors: Ana Isabel Pinho, Miguel Martins de Carvalho, Cátia Oliveira, Luís Daniel Santos, Tânia Proença, Ricardo Alves Pinto, Ana Filipa Amador, Catarina Martins da Costa, João Calvão, André Cabrita, Catarina Marques, Leandro Nóbrega, Lara Dias, Roberto Pinto, Rui André Rodrigues, Filipe Macedo
Journal: Cardiovascular Research (2022)

Abstract A 69-year-old male presented with typical angina while showering. He had history of CABG in 2008 (left internal mammary arterial [LIMA] to the first marginal and intermediate arteries and RIMA to the LAD artery), with preserved biventricular systolic function. On physical examination, an upper-arm systolic blood pressure differential &amp;gt;20mmHg and a decreased pulse amplitude on the left side was found. ECG revealed sinus tachycardia with RBBB, ST-segment depression and inverted T-waves in the lateral and inferior leads. Troponin and BNP levels were elevated. Echocardiogram showed reduced left ventricular ejection fraction (22%) and de novo akinesia of the inferior and posterior walls. The diagnosis of non-ST-segment elevation myocardial infarction was assumed. Coronary angiography revealed patent bypass grafts without disease and a 90% stenosis of the left subclavian artery (LSA) proximal to the ostia of the LIMA, with retrograde flow ‘stealing’ the myocardial blood supply. Ultrasound scan detected systolic reversal of flow in the left vertebral artery, suggesting subclavian-vertebral steal phenomenon. CT-angiography revealed a 14-mm stenosis with a useful lumen of 2 mm in the LSA. A percutaneous balloon angioplasty with stenting of the LSA was performed by the Vascular team, restoring the normal blood supply. Coronary subclavian steal syndrome can manifest as myocardial infarction or heart failure, due to functional LIMA graft failure by inadequate blood supply to the myocardium. Anamnesis and physical examination are fundamental in order not to miss the diagnosis. Subclavian angiography is the gold standard to confirm the diagnosis and can be performed during coronary angiography. Revascularization of the LSA is the definitive treatment. Figure 1Coronary angiography revealed chronic occluded native coronary vessels with patency and no significant disease of the bypass grafts, and high grade (90%) left subclavian artery (LSA) stenosis proximal to the ostia of the LIMA, conditioning the blood flow to the left upper limb and ‘stealing’ the myocardial blood supply because of retrograde flow in the LIMA graft.
Poster No. 044 Cardiovascular risk factors and coronary heart disease in the young – a single centre analysis
Authors: Carolina Miguel Gonçalves, Margarida Cabral, Mariana Carvalho, Adriana Vazão, Sara Fernandes, Rita Carvalho, Fátima Saraiva, João Morais
Journal: Cardiovascular Research (2022)

Abstract Background Cardiovascular events in the young appear to be increasing. Conversely, this is not the tendency reported in older adults. Identifying risk factors is of the uttermost importance to improve cardiovascular prevention. Material and methods Retrospective, single-centre analysis of patients with less than 45 years and suspected coronary heart disease who were subjected to cardiac catheterization in our centre during a 5-year period. Results and conclusions A total of 171 patients were included with a median age of 42 ± 6 years of which 82% were male. Overweight (73%), smoking (61%) and dyslipidemia (42%) were the most prevalent cardiovascular risk factors. Coronary heart disease was diagnosed in 67% of patients. After univariate analysis, gender (P = 0.049), age (P = 0.005), smoking (P = 0.032), low-density lipoprotein cholesterol (P = 0.005) and total cholesterol (P = 0.003) were significantly associated with disease in coronary angiography. After multivariate logistic regression, only age (OR = 1.123; CI 95% [1.036–1.217]; P &amp;lt; 0.005) and low-density lipoprotein cholesterol (OR = 1.016; CI 95% [1.004–1.028]; P = 0.009) remained as independent factors of coronary heart disease. It is known that awareness regarding a healthy lifestyle should be raised in the general population. As several modifiable risk factors have an impact on cardiovascular disease, there is an urgent need to improve primary prevention. Conversely, a more thorough investigation is needed in the cases where no significant coronary disease is found. According to our analysis, age and low-density lipoprotein cholesterol appear to have a stronger relevance in this young population.
Poster No. 117 rs12526196 polymorphism in CCN2 gene is an independent risk factor for ascending thoracic aortic aneurysm
Authors: Isabel Rodríguez, Antonio Tejera-Muñoz, Álvaro Del Río-García, Yamina Mohamedi, María Martín Fernández, Valentina Chiminazzo, Beatriz Suárez-Álvarez, Carlos López-Larrea, Marta Ruiz-Ortega, Raúl Rodrigues-Díez
Journal: Cardiovascular Research (2022)

Abstract Background The Cellular Communication Network Factor-2 (CCN2/CTGF) has been traditionally described as a downstream mediator of other profibrotic factors including transforming growth factor (TGF)-ß and Angiotensin II. However, recent evidence from our group demonstrated the direct role of CCN2 in maintaining aortic wall homeostasis and, in addition, the development of acute and lethal aortic aneurysm induced by Angiotensin II in absence of CCN2 in mice. In order to translate these findings to humans, we evaluated the potential association between three polymorphisms in the CCN2 gene and the presence of thoracic aortic aneurysm (TAA). Material and methods 69 patients with TAA and 297 controls were genotyped for rs6918698, rs9402373 and rs12526196 polymorphisms related to CCN2 gene.Multivariable logistic regression models were performed. Results and conclusions While no associations were found between rs6918698 and rs9402373 with TAA development, patients carrying the C allele from rs12526196 polymorphism have a higher probability of suffering TAA compared to patients with TT genotype, independently of other risk factors such as sex, age, hypertension, type of valvulopathy and presence of bicuspid aortic valve (OR = 3.17; 95% CI = 1.30–7.88;P = 0.011). This study extrapolates to humans the relevance of CCN2 in aortic aneurysm observed in mice and postulate, for the first time, a protective role to CCN2 in aortic aneurysm pathology. Our results encourage future research to explore new variants, polymorphisms or mutations, in the CCN2 gene that could be predisposing to TAA development. Funding Research funded by ISCIII (PI20/000140, PI18/00694, PI19/00184, PI20/00639); RICORS2040-KIDNEY-DISEASE (RD21/0005/0002, RD21/0005/0017); Sara-Borrell-CD20/00042; Miguel-Servet-CP18/00106; Sociedad Española de Nefrología.
Clinical Case 24—Multisite thrombosis in a patient with acute coronary syndrome: when the unlikely becomes reality
Authors: Marius Traian Dragoș Marcu, Cristina Andreea Adam, Radu Andy Sascău, Cristian Stătescu
Journal: Cardiovascular Research (2022)

Abstract We present the case of a 78-year-old patient, admitted for chest pain for 1 week prior to presentation. In the view of the electrocardiographic changes, myocardial cytolysis and severely decreased left ventricular ejection fraction, an acute coronary syndrome was highly likely. Coronary angiography identified a 99% stenosis in the anterior descending artery for which an angioplasty was performed. Afterwards, the patient becomes dyspneic, hemodynamically unstable, suggesting a pulmonary embolism. The pulmonary CT angiography confirmed the presence of a thrombus in the right pulmonary artery. During thrombolysis, the patient was hemodynamically stable, without complications, achieving improvement of symptoms. The next day, the patient had pain at the inguinal level and a significant decrease in hemoglobin. A soft tissue ultrasound was performed, showing a partially thrombosed femoral pseudoaneurysm. Vascular Doppler ultrasound revealed multiple occlusive thrombi in the femoral, popliteal and posterior tibial veins. Echocardiography confirms the presence of floating thrombi in the right ventricle. After a first dose of Apixaban the patient develops erythema. Allergology tests showed intolerance to Apixaban. Considering the associated pro-coagulant status, we performed a series of biological and imaging explorations that showed the presence of a malignant brain neoplasm that induced the complications mentioned above. Unfortunately, the patient died one month after discharge. The occurrence of pulmonary embolism secondary to revascularized acute myocardial infarction, apparently without risk factors, requires identification of underlying pathologies associated with a pro-coagulant status. Unfortunately, often, behind such events, we discuss about an oncological pathology. Figure 13D reconstruction of right pulmonary artery thrombosis.
Oral Presentation No. 03 Growth differentiation factor-15 and bleeding complication risk in patients with coronary artery disease, receiving combined antithrombotic therapy
Authors: E Krivosheeva, A Komarov, A Dobrovolsky, E Titaeva, T Balakhonova, E Panchenko
Journal: Cardiovascular Research (2022)

Abstract Introduction Recent studies are aimed to find laboratory predictors of bleeding complications in patients receiving various regimens of antithrombotic therapy. One of these biomarkers is GDF-15. Purpose To study the significance of GDF-15 in relation to the development of bleeding outcomes in CAD patients with multifocal atherosclerosis, receiving combined antithrombotic therapy. Methods The data was obtained from the prospective registry REGATA-1 (NCT04347200). 122 patients (90 males), median age 69 [IQR 64; 76] yrs) with CAD and peripheral atherosclerosis of at least one vascular territory (≥ 50%), were enrolled. Half of the patients (47.5%) with sinus rhythm received acetylsalicylic acid in combination with rivaroxaban 2.5 mg bid. Other patients (52.5%) with concomitant atrial fibrillation received direct oral anticoagulants in combination with antiplatelet therapy after elective PCI. Median follow-up was 10 months [IQR 7.0;12.0]. The safety end point was BARC 2–5 bleedings. Plasma samples for GDF-15 identification were taken at the inclusion and analyzed using ELISA. Results Frequency of BARC 2–5 bleedings was 14%. Median GDF-15 level was 1248.5 pg/ml [947.8; 1791.0]. According to the quartile analysis, GDF-15 values in the top three quartiles of the distribution (cut-off value &amp;gt; 948 pg/ml) were associated with higher frequency of bleeding events: 3.1% versus 17.8%, P = 0.0411. Bleeding-free survival in groups, formed depending on the level of GDF-15 (948 &amp;gt; and ≤ 948 pg/ml), was 96.7% vs. 82.2%, respectively, Log-Rank P = 0.0408. Conclusions Increase in GDF-15 level (&amp;gt; 948 pg/ml) is associated with the development of BARC 2-5 bleedings in CAD patients with multifocal atherosclerosis, receiving combined antithrombotic therapy.